A lack of imagination is holding us back

In New York 1947, 5 million people were vaccinated in 2 weeks

Like many, I have been puzzled by the seemingly slow vaccine rollout in the UK, US and many other countries. I do not automatically assume incompetence or bad actors. At first, I do not even automatically assume the vaccine roll out is slow. I thought I should investigate further. But slow it seems to be, although not everywhere.

Israel is at 4-5x the pace of the UK and close to 10x the pace of the US. The United Arab Emirates is almost 3x the pace of the UK. Although the UK and US are doing better than Germany and France.

How are we doing relative to history? We have built things fast in history (see Patrick Collinson list end). For instance:

On 24 June 1948, the Soviet Union initiated a blockade of Berlin. Two days later, the Berlin Airlift commenced. Over the following 463 days, the US, the UK, and France flew 277,000 flights with 300 aircraft to deliver the supplies required to support 2.2 million Berlin residents. On average, a supply aircraft landed every 2 minutes for 14 months.

I found a recent NYT article on how New York ran a vaccination programme in 1947 (link end). I went to the orginal review of the programme by Dr. Weinstein.

5 million people were vaccinated in 2 weeks and 6.35 million in less than a month.

The original article in the American Journal of Public Health (1947) is available here to review (link end)

Dr Weinsten writes:

Vaccination stations were set up in all police precincts, in addition to Health Department buildings and municipal hospitals and clinics. There was a total of 179 city installations being used for vaccination. Practically every hospital in the city setup a special clinic where vaccinations were given to all who applied, free of charge. The vaccine was furnished by the Health Department and was administered by doctors on the hospital staff. Many community organizations setup local centers staffed by volunteer physicians and clerks. 

Labour and industry cooperated by establishing vaccination stations in factories offices and union headquarters. In some cases their own positions did the vaccinating and others it was performed by health Department personnel. The station is maintained by the city remain open from 9 am until 10 pm including Saturdays and Sundays on April 26 those at the police print sinks were discontinued and on May 3 all other stations were closed. 

(The vaccination plan was drafted after 4 April).

The NYT article and a quick glance at other commentators have suggested these reasons for being slower today:

• Regulation. This is at a city level vs centralised. But also the bureaucracy around registering volunteers.

• Logistic delays. This is in getting vaccines to doctors. And quality control testing that is required (although that is partly regulation). 

• Priortisation schedules. A complex process behind evaluating which batches go where. Essentially trying to get priority cohorts covered first.

• Manufacturing Capacity. These are delays in glass vials, fill/finish capacity in specialised glass rather than pure vaccine supply.

• A lack of trust in government. This supposedly means problems with vaccine hesitancy.

• A lack of public health infrastructure.

Now while there seem to be elements of truth to those causal ideas many of them do not seem to hold up to the challenges in 1947. Health infrastructure today is more sophisticated and more plentiful both in absolute and per capita basis. The regulatory and logistical burden can part explain the gap and for instance the UK has much more vaccine than it has been able to administer but we certainly have capacity to do and I think we have both state and private capacity.

My theory is that we lack imagination. Or more precisely, the people in leadership positions either lack imagination or are too risk adverse in outlining a more ambitious plan.

Rather than saying why, we should be saying why not?

Rather than  a focus on errors of commission - taking a bad action - like lack of paper work for a volunteer - we ignore the errors of omission - simply taking good decisions.

What would that mean in practice? Applying 3 minutes of imagination time, I come up with the below. I am sure a group of school children allowed to use their imagaination could do better in a day.

• Why not co-opt all police stations, fire stations and like?

• Why not co-opt every pharmacy of size, and the expertise of the pharmacists, both public and private? Not only community pharmacies. (Sun newspaper claims offers from the private sector were shunned, although it’s not obvious if this has now been taken up - I’m unsure why they can not have been involved from the start)

• Why not set up temporary open air type vaccination stations in our major parks in our cities?

• Why not co-opt major business head quarters and industrial parks or gyms or leisure centres or restaurant chains.

• Why not drive-ins?

• Why not co-opt schools and all the places we use for polling?

• Why not convince the logistics experts of Amazon and the like to take a sabbactical and help run our services (and give them so authority to have things done)

Countries probably don’t even have to be as extreme to have better roll outs. They could copy Israel (which also has an over 60 and key worker prioritisation list).

“In Israel our paramedics or nurses are able to travel with a set of 50 to a very distant point without wasting one single shot."

The country has 335 "drive-through" vaccination centres which operate extended hours.

At one, in the northern city of Haifa, doctor and recipient Natalie Roynik was in, jabbed and out in minutes without leaving the driving seat. (From Sky news)

And

Distributing the jabs quickly is crucial, and this is one area where the eagerness among Israelis to get vaccinated is accelerating the effort. Interest is so high that every day, queues of younger people hoping for leftover doses form in front of inoculation stations. WhatsApp groups filled with people contacting each other to secure these doses have also appeared.

And copy our past in terms of public information roll outs and co-opting private/public spaces to help. I know the UK is rolling outmass vaccination centres and using its health infrastructure, but we simply seem slow and it doesn’t necessarily seem a lack of resources. And while we can laud the Israeli use of digital health, New York City 1947 didn’t need digitisation.

There are legitimate debates around state capacity and if the right amount of investment has been made in the right areas.

However, my sense is this is not so much a state capacity problem in tangible infrastructure but a deficit within intangible capacity. In this case the imagination to dream more ambitiously and then the know how and social capital to make it happen.

The silver linings...Israel could be fully vaccinated in 3 months. 

The UK could take anywhere between 6 months to 12 months depending on how the roll out pace continues. 

I sincerely wish we could replicate some of the speed of the past.

https://www.thesun.co.uk/news/13661315/high-street-pharmacies-1m-covid-jabs-snubbed-vaccinate/

NYT article on 1947 vaccination.

The original article in the American Journal of Public Health (1947) is available here to review

Patrick Collison list of fast building.